Postpartum Superior Sagittal Sinus Thrombosis: A Case Report

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare disease. Early diagnosis and treatment are important, as CVST is potentially fatal. Pregnancy and puerperium are known risk factors for CVST. Here, we report the case of a patient who developed superior sagittal sinus thrombosis after a normal vaginal delivery. A 20-year-old woman presented with a headache and seizures two days after a normal vaginal delivery. Initially, brain computed tomography (CT) showed a subarachnoid hemorrhage in the right parietal lobe and sylvian fissure, together with mild cerebral edema. CT angiography revealed superior sagittal sinus thrombosis. Multiple micro-infarctions were seen on diffusion-weighted magnetic resonance images. An intravenous infusion of heparin and mannitol was administered immediately. Two days after treatment initiation, the patient showed sudden neurological deterioration, with left-sided hemiplegia. Brain CT showed moderate brain edema and hemorrhagic densities. Emergency decompressive craniectomy was performed, and heparin was re-administered on post-operative day (POD) 1. On POD 9, the patient's mental state improved from stupor to drowsy, but the left-sided hemiplegia persisted. CT angiography showed that the superior sinus thrombosis had decreased. Superior sagittal sinus thrombosis is an uncommon complication, with an unfavorable outcome, after delivery. Timely diagnosis and treatment are important for preventing neurological deterioration.

Keywords: Cerebral infarction; Cerebral venous sinus thrombosis; Puerperium.

FIGURE 1. (A) Initial brain computer tomography (CT) shows acute infarct in the right high parietal lobe subcortical/deep white matter and left cerebellar hemisphere. Also evident is subarachnoid hemorrhage on the right sylvian fissure, and frontotemporal convexity sulci. There is no apparent midline shift before exacerbation. (B) Follow-up brain CT shows the aggravating venous infarct, with focal hemorrhage on the right high frontoparietal lobe, and swelling after exacerbation.

FIGURE 2. Computer tomography (CT)-digital subtraction angiography shows more resolving progression, interval decreased extent of superior sagittal sinus thrombosis (left: initial CT angiography, right: follow-up CT angiography).

FIGURE 3. Chest computer tomography angiography shows pulmonary thromboembolism at the pulmonary trunk bifurcation, and both pulmonary arteries in the right lower, left upper and left lower lobes.